Naloxone Training Evaluation Survey

Please complete the evaluation for today’s training session-your feedback is valuable to us and appreciated. Indicate how much you agree or disagree to the following statements by filling in the circle that reflects your answer.

	Very Confident	Moderately Confident	Neutral	Slightly Confident	Not at All Confident
Increased knowledge and awareness related to prescription drug and opioid abuse.	Increased knowledge and awareness related to prescription drug and opioid abuse. Very Confident	Increased knowledge and awareness related to prescription drug and opioid abuse. Moderately Confident	Increased knowledge and awareness related to prescription drug and opioid abuse. Neutral	Increased knowledge and awareness related to prescription drug and opioid abuse. Slightly Confident	Increased knowledge and awareness related to prescription drug and opioid abuse. Not at All Confident
Find resources (disposal sites, naloxone, etc.) related to opioids.	Find resources (disposal sites, naloxone, etc.) related to opioids. Very Confident	Find resources (disposal sites, naloxone, etc.) related to opioids. Moderately Confident	Find resources (disposal sites, naloxone, etc.) related to opioids. Neutral	Find resources (disposal sites, naloxone, etc.) related to opioids. Slightly Confident	Find resources (disposal sites, naloxone, etc.) related to opioids. Not at All Confident
Identify resources to connect patients with treatment resources.	Identify resources to connect patients with treatment resources. Very Confident	Identify resources to connect patients with treatment resources. Moderately Confident	Identify resources to connect patients with treatment resources. Neutral	Identify resources to connect patients with treatment resources. Slightly Confident	Identify resources to connect patients with treatment resources. Not at All Confident
Recognize an opioid overdose.	Recognize an opioid overdose. Very Confident	Recognize an opioid overdose. Moderately Confident	Recognize an opioid overdose. Neutral	Recognize an opioid overdose. Slightly Confident	Recognize an opioid overdose. Not at All Confident
Safely use, store, and dispose prescription drugs.	Safely use, store, and dispose prescription drugs. Very Confident	Safely use, store, and dispose prescription drugs. Moderately Confident	Safely use, store, and dispose prescription drugs. Neutral	Safely use, store, and dispose prescription drugs. Slightly Confident	Safely use, store, and dispose prescription drugs. Not at All Confident
Administer Naloxone.	Administer Naloxone. Very Confident	Administer Naloxone. Moderately Confident	Administer Naloxone. Neutral	Administer Naloxone. Slightly Confident	Administer Naloxone. Not at All Confident

Very Confident

Moderately Confident

Neutral

Slightly Confident

Not at All Confident

Increased knowledge and awareness related to prescription drug and opioid abuse.

Increased knowledge and awareness related to prescription drug and opioid abuse. Very Confident

Increased knowledge and awareness related to prescription drug and opioid abuse. Moderately Confident

Increased knowledge and awareness related to prescription drug and opioid abuse. Neutral

Increased knowledge and awareness related to prescription drug and opioid abuse. Slightly Confident

Increased knowledge and awareness related to prescription drug and opioid abuse. Not at All Confident

Find resources (disposal sites, naloxone, etc.) related to opioids.

Find resources (disposal sites, naloxone, etc.) related to opioids. Very Confident

Find resources (disposal sites, naloxone, etc.) related to opioids. Moderately Confident

Find resources (disposal sites, naloxone, etc.) related to opioids. Neutral

Find resources (disposal sites, naloxone, etc.) related to opioids. Slightly Confident

Find resources (disposal sites, naloxone, etc.) related to opioids. Not at All Confident

Identify resources to connect patients with treatment resources.

Identify resources to connect patients with treatment resources. Very Confident

Identify resources to connect patients with treatment resources. Moderately Confident

Identify resources to connect patients with treatment resources. Neutral

Identify resources to connect patients with treatment resources. Slightly Confident

Identify resources to connect patients with treatment resources. Not at All Confident

Recognize an opioid overdose.

Recognize an opioid overdose. Very Confident

Recognize an opioid overdose. Moderately Confident

Recognize an opioid overdose. Neutral

Recognize an opioid overdose. Slightly Confident

Recognize an opioid overdose. Not at All Confident

Safely use, store, and dispose prescription drugs.

Safely use, store, and dispose prescription drugs. Very Confident

Safely use, store, and dispose prescription drugs. Moderately Confident

Safely use, store, and dispose prescription drugs. Neutral

Safely use, store, and dispose prescription drugs. Slightly Confident

Safely use, store, and dispose prescription drugs. Not at All Confident

Administer Naloxone.

Administer Naloxone. Very Confident

Administer Naloxone. Moderately Confident

Administer Naloxone. Neutral

Administer Naloxone. Slightly Confident

Administer Naloxone. Not at All Confident

Naloxone Training Evaluation

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* 1. Please provide the following information:

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* 2. Which county do you represent?

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* 3. After attending this training, how confident are you that you can do the following?

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* 4. I feel confident I can administer Naloxone.

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* 5. I am informed and have the skills and knowledge to respond if needed.

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* 6. Is there any additional information you would like to gain following this training?

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* 7. Please provide additional feedback and comments below: